Dad's exercise before conception impacts child's lifelong health

Recent studies have linked development of type 2 diabetes and impaired metabolic health individuals to their parents' poor diet, and there is increasing evidence that fathers play an important role in obesity and metabolic programming of their offspring.

In a new study published today in the journal Diabetes, researchers at Joslin Diabetes Center have shown that paternal exercise has a significant impact on the metabolic health of their offspring well into adulthood.

The study was led by Laurie Goodyear, PhD, senior investigator and head of the Section on Integrative Physiology and Metabolism at Joslin and professor of medicine at Harvard Medical School. The study was co-led by Kristin Stanford, PhD, a physiology and cell biology researcher who is now with The Ohio State University College of Medicine at the Wexner Medical Center.

Goodyear and Stanford investigated how a father's exercise regimen would affect his offspring's metabolic health. Using a mouse model, they fed male mice either a normal diet or a high-fat diet for three weeks. Some mice from each diet group were sedentary and some exercised freely. After three weeks, the mice bred and their offspring ate a normal diet under sedentary conditions for a year.
The researchers report that adult offspring from sires who exercised had improved glucose metabolism, decreased body weight and a decreased fat mass.

"It really shows how important it is for men to exercise prior to conceiving because it will have lifelong effects on the health of their offspring. When we put the males on a high-fat diet, it had a terrible effect on the offspring; but what was surprising was that situation was completely reversed when the male added in exercise. So translated to humans, even if dad isn't eating really well, he can still affect his offspring positively by exercising," said Goodyear. "This also will dramatically decrease the risk of developing type 2 diabetes for the offspring," added Goodyear.
The team also found that exercise caused changes in the genetic expression of the father's sperm that suppress poor dietary effects and transfer to the offspring.
"We saw a strong change in their small-RNA profile. Now we want to see exactly which small-RNAs are responsible for these metabolic improvements, where it's happening in the offspring and why," Stanford said.
The researchers believe the results support the hypothesis that small RNAs in sperm could help transmit paternal environmental information to the next generation.

For the brokenhearted, grief can lead to death

Grief can cause inflammation that can kill, according to new research from Rice University.

The study, "Grief, Depressive Symptoms and Inflammation in the Spousally Bereaved," will appear in an upcoming edition of Psychoneuroendocrinology. It examines the impact grief has on human health. It builds on previous research from the lab of Chris Fagundes, an assistant professor of psychological sciences at Rice University and the study's lead author, who studied risk factors for inflammation.

Rice researchers conducted interviews and examined the blood of 99 people who spouses had recently died. They compared people who showed symptoms of elevated grief - such as pining for the deceased, difficulty moving on, a sense that life is meaningless and inability to accept the reality of the loss - to those who did not exhibit those behaviors. The researchers discovered that widows and widowers with elevated grief symptoms suffered up to 17 percent higher levels of bodily inflammation. And people in the top one-third of that group had a 53.4 percent higher level of inflammation than the bottom one-third of the group who did exhibit those symptoms.

"Previous research has shown that inflammation contributes to almost every disease in older adulthood," Fagundes said. "We also know that depression is linked to higher levels of inflammation, and those who lose a spouse are at considerably higher risk of major depression, heart attack, stroke and premature mortality. However, this is the first study to confirm that grief -- regardless of people's levels of depressive symptoms -- can promote inflammation, which in turn can cause negative health outcomes."

This finding is an important revelation in the study of how human behaviors and activities impact inflammation levels in the body, Fagundes said, and it adds to a growing body of work about how bereavement can affect health. His initial work showed why those who have been widowed are at higher risk of cardiovascular problems, bodily symptoms and premature mortality by comparing inflammation in spousally bereaved individuals to matched controls.
"This work shows who, among those who are bereaved, are at highest risk," Fagundes said. "Now that we know these two key findings, we can design interventions to target this risk factor in those who are most at risk through behavioral or pharmacological approaches."

Eating leafy greens could help prevent macular degeneration

A new study has shown that eating vegetable nitrates, found mainly in green leafy vegetables and beetroot, could help reduce your risk of developing early-stage age-related macular degeneration (AMD).

Researchers at the Westmead Institute for Medical Research interviewed more than 2,000 Australian adults aged over 49 and followed them over a 15-year period.

The research showed that people who ate between 100 to 142 mgs of vegetable nitrates each day had a 35% lower risk of developing early AMD than people who ate less than 69mgs of vegetable nitrates each day.

Lead Researcher Associate Professor Bamini Gopinath from the Westmead Institute and the University of Sydney said the link between vegetable nitrates and macular degeneration could have important implications.

"This is the first time the effects of dietary nitrates on macular degeneration risk has been measured.
"Essentially we found that people who ate 100 to 142 mgs of vegetable nitrates every day had a reduced risk of developing early signs of macular degeneration compared with people who ate fewer nitrates.
"If our findings are confirmed, incorporating a range of foods rich in dietary nitrates - like green leafy vegetables and beetroot - could be a simple strategy to reduce the risk of early macular degeneration," Associate Professor Gopinath said.
Spinach has approximately 20mg of nitrate per 100g, while beetroot has nearly 15mg of nitrate per 100g.
The research did not show any additional benefits for people who exceeded 142mgs of dietary nitrate each day. It also did not show any significant connections between vegetable nitrates and late stage AMD, or between non-vegetable nitrates and AMD risk.
One in seven Australians over 50 have some signs of macular degeneration.
Age is the strongest known risk factor and the disease is more likely to occur after the age of 50.
There is currently no cure for the disease.
The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992.
It is one of the world's largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases.
"Our research aims to understand why eye diseases occur, as well as the genetic and environmental conditions that may threaten vision," Associate Professor Gopinath concluded.

Healthy diets linked to better outcomes in colorectal cancer

Colorectal cancer patients who followed healthy diets had a lower risk of death from colorectal cancer and all causes, even those who improved their diets after being diagnosed, according to a new American Cancer Society study.

There are more than 1.4 million colorectal cancer (CRC) survivors in the United States. Previous studies have suggested a strong influence of diet quality in disease outcomes, and that some pre- and postdiagnosis dietary components are related to survival in men and women with CRC. But studies of dietary patterns to assess overall diet quality in relation to overall and CRC-specific mortality are inconsistent, making the development of evidence-based recommendations for CRC survivors difficult.

To learn more, investigators led by Mark A. Guinter, PhD, MPH, American Cancer Society post-doctoral fellow, reviewed data from 2,801 men and women diagnosed with CRC in the American Cancer Society's large, prospective Cancer Prevention Study-II (CPS-II) Nutrition Cohort. They found those whose pre- and postdiagnosis diets were consistent with the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention had lower all-cause and CRC specific mortality.
Pre-diagnosis diets that most closely aligned with ACS dietary recommendations were associated with a 22% lower risk of all-cause mortality compared to those on the other end of the spectrum. Significant inverse trends were observed for CRC specific mortality, as well. For the highest quartile of pre-diagnosis Western dietary pattern, which is characterized by high intakes of red meat and other animal products, there was a 30% higher risk of CRC death compared with the lowest quartile.
Postdiagnosis dietary patterns were also significantly associated with the risk of death. The highest compared with the lowest ACS-score showed a 65% lower risk of CRC mortality and a 38% lower risk of mortality from all causes.
The study authors say additional diet patterns and scores that also were based on plant foods and low red and processed meat consumption corroborated their main findings. They conclude that the results suggest the importance of diet quality as a potentially modifiable tool to improve prognosis among men and women with CRC.
"This study is this first to our knowledge that considered change in diet quality across the CRC continuum," said Guinter. "These results suggest that high diet quality after diagnosis, even if poor before, may be associated with a lower risk of death."

Muscle mass should be a new vital sign, research shows

IMAGE: This infographic details the link between muscle mass and a person's overall health status, and highlights key findings from theAnnals of Medicine review paper. view more 

Adults go to the doctor roughly three times a year.¹ During their visit, vitals are taken such as blood pressure, pulse, and weight, but are these measurements really showing the full picture of a person's overall health? Extensive research shows health care professionals should be considering something often overlooked -- muscle mass. A new review paper published in Annals of Medicine, and supported by Abbott, confirms the critical role muscle mass plays in health with studies demonstrating that people with less muscle had more surgical and post-operative complications, longer hospital stays, lower physical function, poorer quality of life and overall lower survival.²

The review examined the latest research over the course of a year (January 2016 - January 2017) including more than 140 studies in inpatient, outpatient and long-term care settings, and had one resounding conclusion -- muscle mass matters. The data show muscle mass can say a lot about a person's overall health status, especially if living with a chronic disease. For example:

• A study in the Journal of the American Medical Association (JAMA) showed women with breast cancer who had more muscle had a nearly 60 percent better chance of survival.³
• Patients in the intensive care unit (ICU) with more muscle spend less time on the ventilator -- as well as less time in the ICU -- and have a better chance of survival.^4,5,6
• People with chronic obstructive pulmonary disease (COPD) who have more muscle experience better respiratory outcomes and lower occurrence of osteopenia or osteoporosis.^7,8
• In the long-term care setting, a study found individuals with lower muscle mass had more severe Alzheimer's.⁹

"Muscle mass should be looked at as a new vital sign," said Carla Prado, Ph.D., R.D., associate professor at the University of Alberta and principal author of the paper. "If healthcare professionals identify and treat low muscle mass, they can significantly improve their patients' health outcomes. Fortunately, advances in technology are making it easier for practitioners to measure muscle mass."
MUSCLE UP FOR BETTER HEALTH For decades, healthcare professionals have relied on body mass index (BMI) to assess a person's health, mainly because it requires a simple calculation. But, this measurement can be misleading since it doesn't distinguish between muscle mass and fat mass. Low muscle mass can occur at any body weight, so someone who is normal weight may appear healthy, when they can in fact lack muscle. While there's potential for body composition tools -- which measure muscle mass -- to become more routinely used and available in healthcare settings, health professionals can use screening questionnaires and other simple methods to identify people at risk.
"Muscle may be skin deep, but it should be top of mind based on the growing body of science," said Suzette Pereira, Ph.D., research scientist at Abbott and one of the paper authors. "Something as simple as the firmness of a person's handshake can give a lot of insight into their overall health, and it's never too late to rebuild muscle with good nutrition, including protein, and proper exercise."
To learn more about the signs of muscle loss and get tips for regaining strength, visit Abbott's Nutrition Newsroom.

Risky sedative prescriptions for older adults

IMAGE: Counties varied widely in intensity of benzodiazepine prescribing by local primary care providers to Medicare Part D patients. view more 

Credit: University of Michigan

Despite years of warnings that older adults shouldn't take sedative drugs that put them at risk of injury and death, a new study reveals how many primary care doctors are still prescribing them, how often, and exactly where.
Mapped out county by county, the study shows wide variation in prescriptions of the drugs, called benzodiazepines. Some counties, especially in the Deep South and rural western states, had three times the level of sedative prescribing as others.
The study also highlights gaps at the level of individual prescribers: Some primary care providers prescribed sedatives more than six times more often than their peers. These high-intensity prescribers of drugs such as Xanax, Ativan and Valium also tended to be high-intensity prescribers of opioid painkillers.
The counties with the most intense sedative prescribing also tended to have lower incomes, less-educated populations, and higher suicide rates, the study finds. They also overlap with other maps showing high county-level opioid painkiller prescribing.
"Taken all together, our findings suggest that primary care providers may be prescribing benzodiazepines to medicate distress," says Donovan Maust, M.D., M.Sc., the geriatric psychiatrist from the University of Michigan who led the study. "And since these drugs increase major health risks, especially when taken with opioid painkillers, it's quite possible that benzodiazepine prescribing may contribute to the shortened life expectancies that others have observed in residents of these areas."
Published in the Journal of General Internal Medicine by a team from U-M Department of Psychiatry and the University of Pennsylvania, the study shows the power of data to highlight persistent inappropriate use of medications.
Prescribing totals
The study is based on data about all prescriptions written in 2015 by primary care providers for patients in the Medicare Part D prescription drug program. The researchers combined it with county-level health and socioeconomic data from the County Health Rankings project.
In the single year studied, the 122,054 primary care providers included in the study prescribed 728 million days' worth of benzodiazepines to their patients, at a cost of $200 million.
The states with the highest intensity of prescribing -- which the researchers defined as the proportion of all medication days prescribed that were of benzodiazepines--were Alabama, Tennessee, West Virginia, Florida and Louisiana, while Minnesota, Alaska, New York, Hawaii and South Dakota had the lowest.
Across all types of providers, primary care and otherwise, benzodiazepines accounted for 2.3 percent of all medication days prescribed to Part D participants by those providers that year.
Primary care doctors accounted for 62 percent of the total. In fact, the researchers focused on primary care providers specifically because previous studies had showed they account for the majority of benzodiazepines prescribed to older adults, who are much less likely than younger adults to see a psychiatrist.
Higher sedative prescription intensity was also associated at the county level with more days of poor mental health, a higher proportion of disability-eligible Medicare beneficiaries, and a higher suicide rate.
More about sedative risks
Benzodiazepines have often been prescribed to ease anxiety or insomnia, though several studies by Maust and others have shown that patients receiving the drugs often don't have a formal diagnosis of either condition.
But the drugs come with a price: clouded thinking ability, higher risk of auto accidents, falls and fractures, and a tendency to hook patients into long-term use despite their intended use as a short-term treatment. Benzodiazepines as a class are the second-most common group of drugs associated with medication-related overdose deaths, right behind opioid painkillers.
Such risks have landed benzodiazepines on the national guideline for prescription drugs that people over age 65 shouldn't take, though their short-term use in treating anxiety or insomnia that haven't responded to other options is still considered acceptable.
More about the study
To contribute to the county-level study, a given primary care provider had to prescribe a benzodiazepine at least 10 times in 2015. For the individual physician-level study, 109,700 doctors were studied, since the 10 percent of prescribers who saw the fewest Medicare beneficiaries were excluded.
The researchers divided individual prescribers into four groups according to the intensity level of their benzodiazepine prescribing.
The range was large - for the lowest group, about 0.6 percent of their total prescriptions were for benzodiazepines, compared with 3.9 percent of the highest-intensity group. That's a 6.5-fold difference in benzodiazepine prescribing.
Those in the highest-intensity group were also likely to be high-intensity prescribers for opioids and antibiotics, and also for other drugs that have been classed as high-risk for older adults.
"That the same providers appear to be high-intensity prescribers of both medications is potential cause for concern," says Maust.
Female primary care providers were less likely to be high-intensity benzodiazepine prescribers. The more years a physician had been in practice, the higher their chance of being a high-intensity prescriber.
Physicians with higher percentages of patients who were white, or who received the "Extra Help" payments available to low-income, low-resource patients under Part D of Medicare were also more likely to be high-intensity sedative prescribers.
The researchers could not see data down to the patient-level in the available Medicare data, so they couldn't look at what conditions patients were listed as having, other clinical findings, or the patients' individual social and economic status.

Aerobic exercise has antidepressant treatment effects

An analysis of randomized controlled clinical trials indicates that supervised aerobic exercise has large antidepressant treatment effects for patients with major depression. The systematic review and meta-analysis is published in Depression and Anxiety.

Across 11 eligible trials involving 455 adult patients (18-65 years old) with major depression as a primary disorder, supervised aerobic exercise was performed on average for 45 minutes, at moderate intensity, 3 times per week, and for 9.2 weeks. It showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.

Also, aerobic exercise revealed moderate-to-large antidepressant effects among trials with lower risk of bias, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks) and trials involving preferences for exercise.

Subgroup analyses revealed comparable effects for aerobic exercise across various settings and delivery formats, and in both outpatients and inpatients regardless of symptom severity.

"Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services," said lead author Dr. Ioannis D. Morres, of the University of Thessaly, in Greece.